Provider Demographics
NPI:1467616771
Name:MACBRIDE, LESLIE ROSS (MS, LP, PHD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ROSS
Last Name:MACBRIDE
Suffix:
Gender:F
Credentials:MS, LP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MARKET STREET
Mailing Address - Street 2:SUITE 4A COUNSELING ASSOCIATES, LLC
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5901
Mailing Address - Country:US
Mailing Address - Phone:507-452-5033
Mailing Address - Fax:507-452-5183
Practice Address - Street 1:111 MARKET STREET
Practice Address - Street 2:SUITE 4A COUNSELING ASSOCIATES, LLC
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5901
Practice Address - Country:US
Practice Address - Phone:507-452-5033
Practice Address - Fax:507-452-5183
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist